Two Experts Do Battle Over Potty Training

By ERICA GOODE

Published: January 12, 1999

Toilet training is not rocket science, says John Rosemond, a syndicated columnist and best-selling author of parenting books. He considers it ''a slap to the intelligence of a human being that one would allow him to continue soiling and wetting himself past age 2.'' The process, he says, should be as simple and straightforward as housebreaking a 4-month-old puppy.

The noted pediatrician T. Berry Brazelton says there is more to it than that. Parents who force toilet training, he says, can cause lasting problems. ''Don't rush your toddler into toilet training or let anyone else tell you it's time -- it's got to be his choice,'' Dr. Brazelton advises in a television commercial for Pampers size-6 diapers, suitable for children 35 pounds and over.

What does he think about Mr. Rosemond's arguments? ''They sound very logical -- for a puppy.''

So goes the newest round in the toilet-training wars.

The previous round was won by parenting experts like Dr. Brazelton and Dr. Benjamin Spock, who schooled a generation of 1960's parents in a flexible toilet-training approach.

But over the last few decades, the age at which toddlers become diaper-free has been creeping upward. In 1957, 92 percent of children were toilet-trained by the age of 18 months, studies found. Today the figure for 2-year-olds is just 4 percent, according to a large-scale Philadelphia study. Only 60 percent of children have achieved mastery of the toilet by 36 months, the study found, and 2 percent remain untrained at the age of 4 years.

Moreover, though there are no hard statistics on them, pediatricians say they are seeing more children with toilet-training problems, including withholding of urine and stool, chronic constipation, and wetting and soiling by older children. Dr. Bruce Filmer, an associate professor at Thomas Jefferson University Medical School in Philadelphia, for example, says he and other pediatric urologists have noticed an increase in referrals of young patients experiencing problems with both daytime and nighttime urinary control.

These developments combined have fed a multibillion-dollar diaper industry, which last year had training-pant sales of $545 million, and have spurred the introduction of the giant-sized diaper, designed for toddlers well past the terrible 2's.

The sight of diaper-clad 3- and 4-year-olds does not amuse Mr. Rosemond, a family psychologist who advocates a return to traditional child-rearing practices, and he has decided to do public battle on the issue.

In a series of columns last month, published in more than 100 newspapers, he attributed delayed training to wishy-washy parenting inspired by ''Freudian mumbo jumbo.'' In particular, he pointed to Dr. Brazelton, professor emeritus of pediatrics at Harvard Medical School, who in the 1960's pioneered the ''child-centered'' parenting approach, recommending that parents let their children decide when to become diaper-free.

The increasing tendency for parents to leave the timing of toiling training up to the child, Mr. Rosemond asserted, is largely responsible for the rise in toilet-training difficulties. Delayed training, he said in a telephone interview, can also lead to discipline problems, because mothers spend too much time being servants for their children and do not make the transition soon enough to ''authority figure.''

Mr. Rosemond concedes that Dr. Brazelton has been giving the same advice for decades but also criticizes him for serving as a consultant to Pampers, a product of the Procter & Gamble Company, and for appearing in the Pampers commercial.

For his part, Dr. Brazelton said he believed that the rise in toilet training problems was a result of too much pressure on children, not too little. The increase can be traced to the escalating demands of modern life, he said. Day-care centers often require that children be toilet-trained in order to enroll, and working parents end up leaning on them to comply. Parents share the responsibility for training with nannies and baby sitters, a circumstance that children may find confusing.

''Parents are feeling very guilty, and people like Rosemond are making them feel more guilty, not less,'' Dr. Brazelton said. ''And the child's only recourse is to withhold urine or stool in protest.''

As for his relationship with Pampers, which provides financing for his research and health care projects, Dr. Brazelton said he was proud of the association.

''It took me a long time to decide to do it, but I'm absolutely convinced that it was a wonderful thing to do,'' he said. ''I'm certainly not doing it to keep kids in diapers. It's just the opposite: Pampers is willing to go along with me to make it easier for mothers to let kids be open to toilet training when they are ready.''

To ''go along,'' of course, is not all that difficult for Procter & Gamble, which, like its competitor Kimberly-Clark, maker of Huggies, recognizes a bonanza when it sees it.

Wendy Strong, director of corporate communications for Kimberly-Clark, said the company's own marketing research confirmed that toddlers were toilet training later than in the past: only 12 percent of children are trained at 18 months, the company found, and 85 percent by 30 months. Huggies, too, just began offering customers a size-6 diaper, but the company also makes ''training pants'' for toddlers of 38 pounds or more, a product category, Ms. Strong said, that Kimberly-Clark ''expects to grow to more than a billion dollars by 2002.''

Whichever expert's school of parenting a toddler's parents decide to follow, they run no risk of confusing the philosophies, or the methods themselves.

Mr. Rosemond offers a toilet-training technique he calls ''naked and $75,'' which he recommends that parents embark upon with their 2-year-olds.

''You stay home from work with your child for a few days,'' he said, and ''you let the child walk around the house naked all day long.'' The parent puts the potty where the child spends most of his time, and moves it when necessary to keep it nearby. Every so often, the parent reminds the child to use the potty when needed.

''Children at this age do not like urine and feces running down their legs,'' Mr. Rosemond said. ''When they have an accident, they stop and start to howl, and the mother comes along and says, 'Well, you forgot to use the toilet.' She puts him on the toilet, wipes him off, speaks reassuringly to him. And within three days, or five days, he's doing it on his own.''

The $75, he added, is for the carpet cleaning.

In contrast, Dr. Brazelton, like Mr. Rosemond the author of best-selling parenting manuals, discourages parents from expecting their child to potty-train in a few days. He recommends that parents buy a potty chair and ''show children what is expected of them at 2, what we are all doing and why it is important.''

But, he says, the rate at which training occurs should be left up to the child.

''If your child is afraid of the potty chair, don't put pressure on him to use it,'' Dr. Brazelton advises in a step-by-step guide available on the Pampers Parenting Institute's Web site (www.pampers.com). ''Put toilet training aside for a month or two, and give your child time to get used to the idea of the potty and to be comfortable with it.''

''Be patient and positive,'' the pediatrician suggests. ''As with any new skill, your child will master toilet training in time.''

In his experience, Dr. Brazelton said, 85 percent to 90 percent of children will embrace toilet training soon after they first show an interest.

''But the others are saying that there are other issues they're trying to deal with,'' he said, ''like day care, like parents who are extremely busy. The child gets confused and maybe even angry, and withholds. And at this point I think you have to be able to say, 'This has got to be up to you.' ''

For parents, the bottom line seems to be: Whatever works.

Melissa Saren, for example, a Manhattan lawyer, said she tried introducing her son Matthew to the potty when he was 3. ''But I think looking back on it that I started when I was ready, not when he was ready,'' she said.

For months, nothing seemed to work, not bribes, not the books ''Once Upon a Potty'' or ''Everyone Poops,'' not ''big boy'' underwear. Finally, she said, Matthew decided the time was right -- when he enrolled in day care at 3 1/2.

''Seeing the other boys poop in the potty'' seemed to do the trick, Ms. Saren said. ''I would fall into the category of thinking that you just leave them alone and they'll come to it.''

Other mothers -- Mr. Rosemond said his daughter-in-law was one example -- find that the ''stay at home and do it in three days'' approach works just fine.

But many pediatricians say their experience has landed them much closer to the Brazelton camp than the Rosemond. Dr. Filmer, for example, said he had seen many parents become embroiled in battles with their children if they try to force toilet training within a defined period of time.

''Goodness me,'' Dr. Filmer said, ''you talk to these parents and they will tell you that their children formed almost a fear of toilet training.''

Dr. Bruce Taubman, a pediatrician in the department of gastroenterology and nutrition at Children's Hospital in Philadelphia who has a private practice in Cherry Hill, N.J., said: ''To get a child trained by 2 can be done, but it is probably done at a cost. It takes a tremendous effort.''

But Dr. Taubman said he had a hunch, though he did not yet have data to support it, that there was a window of opportunity, perhaps near the age of 2 or 2 1/2, ''when kids really want their parents to get excited if the kids poop.'' If this opportunity is missed, toilet training may take much longer.

Dr. Taubman is one of the few people who have collected systematic data on toilet training. In 1997, he published the first large-scale study of children's reactions to toilet training since the 1960's, a report on 482 children in suburban Philadelphia. The study appeared in the journal Pediatrics.

In addition to assessing the ages at which most children now train, Dr. Taubman found that boys trained later than girls on average and that the average age at which parents introduced toilet training was 23 months.

There is no relationship, Dr. Taubman found, between when a child is trained and the mother's work status, the presence of siblings, the child's scores on measures of behavior, or whether the child is in day care.

About 13 percent of the children in the study had trouble with toilet training, withholding stool or refusing to use the toilet. But the vast majority of these children, Dr. Taubman said, ''resolved the problem without intervention.''